Thursday, February 16, 2006

Getting Your Eyes Checked, Part II

If you missed my "Getting Your Eyes Checked" article, I urge you to read it.

One of my readers, Kim Ray, wrote:
I suppose it is not uncommon for children to have their first eye exams in kindergarten or first grade, but knowing what I know now, I would tend to this much earlier even if there were no apparent problems. . . .

What's interesting is that our daughter was an early reader and never showed any of the typical signs of vision problems: crossing eye, unwillingness to read, headaches, etc.

[The problem was], the part of her brain receiving the blurry images from her 'bad' eye had given up trying to make sense of things and was allowing the other eye, and its corresponding vision center in the brain, to do all the work. [Getting corrective] glasses, therefore, wasn't enough. Her brain needed to learn to recognize the now corrected images feeding in from the bad eye.

We might have gained several years of improvement in her perception of the corrected images she now sees through her glasses had we discovered her problem earlier. . . .

Vision involves far more than the mechanics of focus, as we found out!
With my experience; with Kim's story; with the stories from all the others who have written to me in the past couple of weeks: I can't stress heavily enough how important I believe a full behavioral or developmental eye exam is . . . and sooner rather than later.

Brief summary of what I have discovered: there's more to a good eye exam than static tests of each eye, individually. About 20% of the U.S. population suffers from significant problems in binocular (two-eye) convergence: we can't get our eyes to work well together. . . And I and my two sons all suffer from these kinds of difficulties. A regular exam shows the optometrist how to correct our vision so each eye sees 20-20; but we still have problems because the two eyes don't cooperate well together.

I appreciated hearing all my correspondents' stories, because they confirmed what my doctor had been telling me--and what I've been reading on the internet.

Part of the reason I asked for the stories is because I wanted to be sure I was sharing good information. At this point, I feel I can speak with a high degree of confidence that what I tell you is accurate.

ADD/ADHD . . . or Eye Difficulties?
Disobedience and Rebelliousness . . . or Eye Difficulties?
Carelessness and Sloth . . . or Eye Difficulties?

I'd like you to consider the following

"Symptom Checklist" of potential eye problems . . . that your regular optometrist may be overlooking

You may have gone to your optometrist several times over, each time convinced that there must be some issue with your or your child's eyes, but each time he or she has assured you: "No. Your [or, your child's] eyes are perfectly fine!"

. . . But they may not be fine. Not if you or your son or daughter is experiencing the following symptoms:

1. Temporary effects on eyesight
* Blurred distance vision (chalkboard or across room) especially after doing desk work or using computer
* Occasional blurring of near vision
* Occasional double vision at distance OR near
* Print or words sometimes appear to float OR move on the page

2. Discomfort associated with reading, desk work or using computer
* Headaches
* Eye rubbing
* Eye fatigue or "strain"
* General, overall fatigue
* Eyes Red, Watery OR Burning

3. Adaptations and postural adjustments during desk or computer work
* Moves head OR uses finger to keep place while reading
* Gets too close to paper during reading or writing
* Tilts OR turns head during reading or writing
* Excessively "wiggly" during reading or desk work
* Covers or closes one eye OR lays head on arm while reading or writing (thus occluding one eye so it cannot see the paper).

4. Has little interest in or enjoyment of reading
* Short attention span for reading
* Dislikes or avoids reading
* Fatigue or sleepiness with reading

5. Difficulty with reading comprehension
* Sub-vocalizes while reading or writing
* Reading comprehension reduces as reading continues
* Slow reader OR takes too long to complete homework

6. Makes "careless" errors when reading or writing OR appears clumsy
* Skips small words when reading OR miscalls similar words
* Difficulty working with columns of numbers OR staying on lines when writing
* Loses place easily OR skips or re-reads lines
* Makes errors or excessively slow when copying
* Spills things at table OR bumps or trips over things
* Letter or number transpositions or reversals
* Poor handwriting
* Appears clumsy or careless
* Difficulty hitting or catching a ball

Please. Let me note. These symptoms may seem weird, but if they come from the eyes, you will be extremely happy to find the source of the problem and to get it taken care of.

Along those lines, let me relate the story that Sandie Herr, a homeschooling mom of eight children (age 26 to 5-years-old) told me.

She said their oldest son "was in a private Christian school for kindergarten and first grade. By the end of 1st grade he was a year and three months behind in reading but a year ahead in math. He was young for the grade but big for his age and emotionally mature, so holding him back wasn't a good solution. We had him tested and his IQ was fairly high. We decided to school him and his older sister for a year at home."

After a year, I knew there was something not right for my son but I didn't know what. We took him to an educational psychologist for testing. Besides some learning difficulties and short term memory issues he also noted a red flag on his eye test--a 3-D type of test. He sent us to a developmental optometrist.

We had a 1 1/2 hour testing session and a two-hour conference on what was wrong with my son's eyes developmentally (20-20 vision) including:

* shutting the vision off from one eye completely,
* failing to be able to track from the end of one line to the start of the other (he either reread the same line, went back a line, or skipped a line),
* seeing double, and
* having his eyes hit at two different spots when shifting from close work to, say, a blackboard, and then having his brain work to bring the images together.

He was working so hard with his eyes that his brain couldn't concentrate on what he was reading. I would ask him questions on what he had just read aloud to me and he couldn't answer me.

He went for eye vision training for once a week for two years to retrain his eyes. He also wore glasses to help aid his focusing during most of that time but not since. It was the best thing we did for him. . .

Having this great experience you would think that we would be extra aware of this type of problem with our other children. Unfortunately, we weren't and our third child a daughter struggled thru her years of schooling with great difficulty. She was such a great athlete and gifted artistically but also had some learning difficulties that we thought schoolwork would just be harder for her. She didn't test well (a red flag we now know) although orally she excelled.

We had a reading specialist help her in high school as she struggled to handle the harder reading workload which helped somewhat. She also struggled with constant headaches in high school and college and had difficulty concentrating on reading for more than five minutes at a time without her eyes unfocusing or looking else where.

When our seventh child, our third and final daughter, started school, things did not go well from the start. It was obvious she too had some learning difficulties although she was a bright child (she had memorized more than two dozen books word perfect so that you thought she was reading them before she was two). We struggled through kindergarten, first grade, and partly through second before I "gave-up" and cried out for help. I just didn't know what was wrong but we were both often in tears over her schoolwork and frustrated.

My search dead-ended several times before I took advantage of a free testing evaluation by Success Labs, a tutorial service in our area. I thought I would at least get some information to be able to know where to look for help. It turned out to be a huge blessing. They, too, saw a red flag on an eye test and recommended the same developmental eye doctor's office my son had used fifteen years ago located several towns away. At the conference after her testing session much of what we talked about also rang some bells for our older daughter, now 20. We had her tested, too. Both of them are now in eye vision training once a week and we are seeing improvement although it is still in the early stages.

This is what I have discovered and seen demonstrated many times over in the past month.

How is a "developmental" (or "behavioral" or "neuro") optometric exam different from a standard exam?

According to Dr. Linda Azwell, a developmental optometric physician in Orlando, Florida,

Both exams will look at the health of the eye and the possible need to have corrective lenses. But a Developmental Eye Exam will also assess how the eyes are working together as a team at distance and especially at near since this can be a source of problems for approximately 20% of the population. The Developmental Exam will measure:

* The ability of the eyes, separately and together, to change their focus rapidly and smoothly
* The amount of flexibility the eyes have to make "turn in" or "turn out" adjustments at distance and at near so the eyes are pointed at what the person actually wants to look at
* Can the eyes actually stay comfortably where the person wants to look at distance and at near without sliding in and out of alignment?
* Does the person have adequate depth perception and ability to see binocularly?
* Can the person follow something smoothly with their eyes or are tiny correctional movements always needed?
* The ability of the eyes to smoothly and accurately move from one point to another:
1) at distance,
2) at near, and
3) from near to distance and back again
* Do they have good orientation, coordination and laterality?

When I first began my visual therapy, three weeks ago, I could not make my eyes converge on a point closer than about a foot away from my face. Now, through therapy, I am becoming relatively adept at such convergence, though one of my eyes continues to "blank out" on a rather frequent and disconcerting basis.

Better than 20-20 . . . but at what cost?

As I have now brought our sons in to see Dr. Manniko, we have discovered several interesting things. For example, one of our sons, Justin, had been measured by our regular optometrist as having 20-12 eyesight--"better than normal." . . . But he has complained for years of suffering headaches. He has always thought it was his eyes. We have brought him to the optometrist, and the optometrist has said he couldn't imagine how. . . .

Dr. Manniko ran him through the same set of tests that a regular optometrist does, then did something I've never seen before: he reset the phoropter (the machine eye doctors set in front of you and flip lenses around and say, "Is this better, or is this?") . . . --He reset the phoropter to some strange setting, asked Justin if he could read the top line of the chart (which Justin, at that point, could not), and then said, "Great! . . . I want you to sit there and relax and wait until you can see something. Then tell me what you see."

It took about three minutes and Justin suddenly called out, "Hey! I can read the first line! It's '____' (whatever it was)."

"That's great!" Manniko replied. "When you can see more, tell me."

A few minutes later, Justin could read the next line.

After about 10 minutes, Justin was able to read four of the six lines on the chart.

What had happened?

Dr. Manniko said that, normally, our eyes are at rest when we are looking at a distance. It takes quite a bit of muscle power to force ourselves to look up close. Justin was, indeed, able to see well, but at the cost of tremendous exertion: "It's like a car that can't go faster than 60 mph even when floored and running downhill. Justin's eyes are that car, and they're trying always to run at 55 mph. A car that can't go faster than 60 mph will achieve the speed, but at tremendous cost--especially if you're always trying to run it at its top capability. Justin's headaches are the result of the constant strain."

Sure enough, with glasses (which he "doesn't need"), his headaches have disappeared.


I'd like to tell a couple more stories, and then I need to quit.

Prismatic Lenses

Dr. Manniko prescribed some prismatic lenses for me. My regular optometrist had said he could make such a prescription, but he warned me that they would be like heroin: totally addictive and, long term, destructive of my eyesight: "You'll become dependent on the lenses to do what your eyes are supposed to do for you."

I asked Dr. Manniko about that. (And I asked a few opticians about the matter as well.)

Manniko said, "He is absolutely right. Your eyes will become weaker. Just as your feet are weaker because you wear shoes. But just as shoes (and your computer and your calculator and so much other technology) are adaptive technology, so are the prismatic lenses: they help you do what you could not do without them. You could not easily walk outside in your bare feet when it is freezing cold and snowy. You could not easily walk on burning hot tarmac in the summer. Shoes help you do those things. The right shoes can help you run faster than you would if you didn't own them. . . . In the same way, prismatic lenses for your condition, John, will help your eyes enable you to do what you want and need them to do."

Long-term, of course, both Manniko and I expect me to do away with the prisms by having me strengthen my eyes through the therapy I'm engaged in.

Fun and Games

The therapy I'm undergoing is rather odd.

There are a few pieces that seem relatively easy to understand. Separate from Dr. Manniko, I purchased an eyesight kit that includes a "Fusion String" that is about six feet long and has a red bead attached every six inches down its length (with about 6" free on each end). You're supposed to attach the string on one end to a wall (I've attached it to a door knob) and then hold the other up to the end of your nose. You're then supposed to sight down the string, focusing on each bead in succession. "If you're nearsighted, start with the closest bead and work outward. If you're farsighted, start with the farthest bead and work up toward you."

I have found this Fusion String to be most enlightening. If your eyes are working as they should, you should actually see "two" strings running down to the point where you are focused; they should fuse at that spot, and then continue, crisscrossed, beyond the focus point. I.e., they should form a giant "X" if you're looking at a bead somewhere in the middle, and a "V" (or upside-down "V") if you're looking at either end.

If you see only one string, then one of your eyes is blanking out. If you see a "Y"-like figure--where one of the legs of the "X" is broken off, that means something else. I have found that I often see a "Y."

But the majority of my therapy is nothing like this at all. Mostly, I play games--games like throwing a ball against a bounce-back net; shooting baskets at mini indoor basketball hoops; walking on a balance beam; playing catch with a partner while the two of us are standing on the balance beam; and so forth. I play these games while wearing heavily prismed glasses.

These glasses range from 3 to 12 diopters of prismatic shift. And the prisms can be rotated. So we start playing these games with the prisms "up"--at the 12 o'clock position. Then shift the prisms "right" (3 o'clock). Then "down" (6). Then "left" (9). Then "out" (left at 9, right at 3). Then "in" (left at 3, right at 9). . . . And for me, since I have an alignment problem where my eyes not only don't converge properly left-to-right (the most common type of difficulty), but also up-and-down, I am supposed to do these things also with the prisms set one down, one up and vice-versa.

Talk about making you feel dizzy! . . . But I am finding that my eyes converge more readily already, and I'm not even a third of the way through my scheduled therapy.

I asked Dr. Manniko about his regimen. He said that the prismatic glasses "merely" speed up the whole process. But the games themselves are really the "secret." He said that far too many kids lack the kind of practice they really ought to have in focusing near-far and far-near in rapid succession.

"Think of it," he said. "To begin with, a child should learn to catch a slow-moving balloon. Eventually, s/he should graduate to a slow, soft ball. And only after plenty of that kind of experience should s/he ever face the kind of situation that a lot of boys face when they are 8 or 9 years old where they are set 90 feet from the pitchers mound and then have a hard ball thrown at them at 40-, 50-, or 60-miles per hour!"

Too many kids today, he said, do little more than stare at computer and video screens. And their eyes don't get the wide range of practice they need to perform optimally. . . .



In sum, if you or one of your loved ones is experiencing any of the issues I listed at the beginning of today's article--or even if not--I urge you to find a "Developmental" or "Behavioral" (or possibly a "Neuro") optometrist and have that person's vision checked out. At least once. If there are no problems, stick with your regular optometrist. But at least once, see how your and your children's eyes work together.

You can find a doctor locally by going to ["developmental" optometry] or ["behavioral" optometry]. "Neuro-Optometrists" are pretty similar to developmental and behavioral optometrists, though they specialize in "rehabilitation for acquired brain injury." A Neuro-Optometrist has a good web page that highlights some of the kinds of issues they deal with. (See To find a neuro-optometric doctor or therapist, go to

One last item (mentioned by several people): "Some docs recommend surgery right off the bat. Other treatments are often as good and less invasive."

Thursday, February 02, 2006

Getting Your Eyes Checked

In the last month, I’ve had two appointments with a specialized "developmental optometrist.” The optometrist pointed out something I have never realized before: static eye exams may ignore some really debilitating eye problems. If your son or daughter is having difficulty with reading, it may not be a problem associated with his or her ability to see clearly (the kinds of measurements that show up on standard phoropter tests (the phoropter is the machine eye doctors set in front of you and flip lenses around and say, "Is this better, or is this?")). It may have everything to do with eye coordination and eye-brain connections--what we may call "perceptual ability."

Let me tell you my story and then I'd like to hear yours.


For years I've known "something" is "wrong" with my eyes. I could never define exactly what bothered (or bothers) me. However, I knew, from my internal sense about these things, that I read very slowly. Not as slowly as some. But I have always sensed I read way more slowly than I'd prefer. And no matter what techniques I try to use to raise my speed, my comprehension always tends to fall rapidly. I *have* to read slowly or I can't understand what I'm reading.

Something else that "SHOULD" have been a clue, but I never paid attention to: for years I've known that I can't read for more than 15 or 20 minutes at a time before I want to fall asleep. I don't mean merely feeling tired. I mean, reading just about literally "knocks me out." I'd fall asleep in mid-sentence when reading to our kids "way back when"--when we used to read together as a family.

When I went to see the developmental optometrist, we talked for a while about the kinds of symptoms I was experiencing. He asked about headaches when I read, about seeing double, about symptoms typical of dyslexia, ADD, ADHD, and other such behavioral and/or perceptual issues.

I could not say anything about these other areas. All I knew is the two symptoms I mentioned above.

After giving me a standard eye exam, he hooked me up to a VisaGraph, which tracked my eye movements as I read . . . each eye INDIVIDUALLY. The VisaGraph tests--we did two of them--were most enlightening.

Here's what they told us: my left eye fixated (stopped to focus on a portion of text) more times than my right eye fixated.

And I went back to re-read something I’d already read (called a reversion) more times with my left eye than my right.

Eyes Not Tracking Correctly

You may wonder: "How could your LEFT eye fixate more times than the right? And how could the left eye revert more times than the right?"

Well, in a graphical printout of my eye movements, the left eye always moved where it needed to go in order to see whatever it was I needed to see. Every now and then, however, my right eye would simply "go blind." It would quit "looking" . . . or seeing. The graph of the left would show distinct and measured movements; the right eye would simply stop moving, or move far less than the left eye. . . .

Rather eerie to see!

But the upshot of all of this: my eyes, though functioning okay ON THEIR OWN or when asked to look at a static object, do not work well TOGETHER.


I want to tell "the rest of the story," but I'm under some tremendous time pressure. I would also like to hear some "war stories" from my readers so, together, we may be able to give better recommendations and "advice" to others whose children may be struggling--or who may find that they themselves may be struggling with their eyes.

So: Have you become aware of these kinds of visual difficulties that show up in "real-life" situations but that your regular optometrist seems to miss? What have you done about it? What have you found? What "solutions" have you discovered?